TREATMENT OF SEVERE BURNS WITH CULTURED K ERATINOCYTE GRAFTS - CLINICAL-EXPERIENCE AND FUTURE ASPECTS

There is a world-wide growing interest in cultured epithelium. It is c ommonly accepted that cultured epithelial auto- or allografts can stim ulate wound healing and shorten re-epithelialization time. Sheets of c ultured autologous epidermal cells have been used for more than 15 yea rs as grafts to achieve permanent coverage of full-thickness burn woun ds. Yet many surgeons who have used cultured epidermal grafts have rep orted a substantial variability in their outcome. The best results hav e been obtained by performing early excision, followed by temporary co verage with a cadaver homograft. Within 3 weeks the donor allodermis i s incorporated and forms a neodermis. The epidermal parts of the donor skin are removed after about 3 weeks and cultured epidermal autograft s are transplanted (composite graft technique). There is some hope tha t progress in the cultivation procedure and a modified transplantation technique will shorten the healing time. In our opinion, great progre ss was made when cryopreserved allogeneic epithelial grafts became ava ilable for the treatment of deep dermal burn wounds. We obtained a goo d re-epithelialization rate (56%) after 9.5 days in 56 cases. In the l ast 25 cases, the re-epithelialization time was 72% after 11.5 days. E specially burn wounds of the face have been treated successfully, avoi ding over-grafting and achieving highly acceptable, aesthetic and func tional results. Many laboratories are developing dermal equivalents, c ombining synthetic and biological materials in order to form a multila yer neodermis. Although it seems possible to cultivate adnexae of the skin, a neodermis with cultivated adnexae is not yet in sight.